Trauma remains one of the leading causes of mortality worldwide and is responsible for nearly one-third of "all lost years of productive life before age 65, exceeding losses from heart disease, cancer, and stroke combined (2)." In 1989, the American College of Surgeons (ACS) established the National Trauma Databank (NTDB) as a national trauma registry. In spite of the fact that the NTDB includes outcomes data on 1.5 million patients from 70% of Level I trauma centers in the United States, there are no national or regional efforts to use this outcomes data to improve outcomes. Specifically, no hospital report card has been developed to measure the quality of trauma care at individual centers. Furthermore, although the Trauma and Injury Severity Scoring (TRISS) methodology is the gold standard for measuring trauma performance, it is no longer accurate. Since TRISS was developed using MTOS data that is now over 20 years old and trauma outcomes have improved over time, the TRISS methodology now over-predicts mortality. At the hospital level, TRISS predicts mortality rates that are too high, giving the misleading impression that hospital performance is better than it actually is. This severely limits the usefulness of TRISS for the purpose of benchmarking and quality improvement. The goal of the proposed project is to use the NTDB as a platform for the development of mortality and functional outcome risk adjustment models, and to evaluate the impact of providing trauma hospitals with information on their risk adjusted outcomes. The primary hypothesis to be tested is that providing trauma hospitals with information on their risk-adjusted outcomes will lead to improved outcomes. Trauma hospitals will be randomized to either receive or not to receive feedback on their comparative performance, and the effect of providing hospitals with benchmarking information will be analyzed. The proposed work will also determine whether "best practices" identified by surveying high-performance hospitals are associated with improved outcomes after controlling for patient risk and hospital quality. The knowledge gained from this project will inform the development of policies designed to improve the quality of trauma care through the establishment of a national population-based Trauma Report Card. Such a National Trauma Report Card could serve as a catalyst for improving short and long-term outcomes for trauma patients.